KEELY REECE THEOBALD (NPI# 1326663683) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326663683 |
| Entity Type | Individual |
| Full Name | KEELY REECE THEOBALD |
| Credential | B.S. |
| Practice Address |
2086 7th Street Charleston IL 61920 |
| Practice Telephone | 2175812712 |
| Mailing Telephone | 2175812712 |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2020-06-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | IL | Student, Health Care |
| Street Address |
2086 7TH STREET |
| City | CHARLESTON |
| State | IL |
| Zip Code | 61920 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124643879 | Jenna Kay Mortensen | Speech-Language Pathologist | 2086 7th Street, Charleston, IL 61920 | 2020-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255954566 | Christina L. White | Nurse Practitioner | 1199 Persimmon Rd, Charleston, IL 61920 | 2020-05-20 |
| 1679066773 | Jennifer Hess | Specialist/Technologist | 2506 Lantz Building, Charleston, IL 61920 | 2018-06-13 |
| 1134647969 | Nichole C Ogilvie | Student in an Organized Health Care Education/Training Program | 917 4th Street Apt 19, Charleston, IL 61920 | 2017-08-31 |
| 1467970319 | Marcus Roach | Physical Therapy Assistant | 912 Oakcrest Dr. Apt D, Charleston, IL 61920 | 2017-08-30 |
| 1114478500 | 5 Guys Rx II LLC | Pharmacy | 1 W Lincoln Ave, Charleston, IL 61920 | 2016-10-20 |
| 1649723206 | Bright Minds Educational Program Inc | Developmental Therapist | 7704 Deerpath Road, Charleston, IL 61920 | 2016-08-01 |
| 1760843379 | Lisa Price | Nurse Practitioner | 2040 Lincoln Ave, Suite 100, Charleston, IL 61920 | 2016-03-09 |
| 1104243385 | Nathan David Schwartzkopf | Specialist/Technologist | 1340 A Street, Charleston, IL 61920 | 2014-03-25 |
| 1558694349 | Emily Schilling | Specialist/Technologist | 2350 Harrison Avenue, Charelston, IL 61920 | 2009-09-10 |
| 1265649289 | Combs Chiropractic and Wellness Center S.c. | Chiropractor | 1200 West Polk Ave., Charleston, IL 61920 | 2007-05-17 |
| Find all providers in zip 61920 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144833823 | Shadi Adib Bashai | Student in an Organized Health Care Education/Training Program | 743 1/2 Washington St W, Charleston, WV 25302-1844 | 2020-08-24 |
| 1043837883 | Jacey Renee Dillon | Student in an Organized Health Care Education/Training Program | 2119 Stoner Dr W, Charleston, IL 61920-3723 | 2020-06-27 |
| 1053931410 | Pir Ali Shah | Student in an Organized Health Care Education/Training Program | 3200 Maccorkle Avenue Southeast Robert C. Bind Clinical, Charleston, WV 25304 | 2020-04-25 |
| 1629698865 | Umer Muhammad | Student in an Organized Health Care Education/Training Program | Childrens Medicine Center, 800 Pennsylvania Ave, Charleston, WV 25302 | 2020-04-17 |
| 1730718891 | Ryan Metts | Student in an Organized Health Care Education/Training Program | 211 Ashley Ave Apt B, Charleston, SC 29403-6859 | 2020-04-02 |
| 1598393506 | Khadija Naseem | Student in an Organized Health Care Education/Training Program | Robert C. Bird Clinical Training Center, 3200 Maccorkle Avenue Southeast, Charleston, WV 25304-1208 | 2020-03-27 |
| 1235766411 | Abhishek Yadav | Student in an Organized Health Care Education/Training Program | 101 29th St Se Apt 20, Charleston, WV 25304-1149 | 2020-03-26 |
| 1649807603 | Jasmine Shah | Student in an Organized Health Care Education/Training Program | 3110 Maccorkle Avenue, Se, Student Services Department - Wvu Building, 4th Floor, Charleston, WV 25304 | 2020-03-26 |
| 1861027815 | Robert Bryce Robbins | Student in an Organized Health Care Education/Training Program | Search Results 171 Ashley Ave, Charleston, SC 29425-0001 | 2020-03-10 |
| 1700426343 | Mikaela Kiser | Student in an Organized Health Care Education/Training Program | 3813 Staunton Ave Se Unit A, Charleston, WV 25304-1537 | 2020-01-12 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 61920 |
Please comment or provide details below to improve the information on KEELY REECE THEOBALD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.